Non-Melanomatous Skin Cancers

Question 1

Progression of photdamaged skin

Answer 1

PD skin to actinic keratosis to SCC in situ 9Bowen’s dz) to invasive SCC

Question 2

Risk factors of actinic keratosis

Answer 2

Mostly UV exposure

Also fair skin, age, immunosuppression

p53 (most common) or ras mutation

Question 3

AK premalignant lesions, if malgnant transform occurs, prognosis, risk of progression

Answer 3

Poentnaitla to progress to cancer but not cancer itself

Typically SCC

Most do NOT progress

Persistance of AK, cumulative UV expsourve, hx of skin cancer, immunosuppression, genetic susceptbility

Question 4

AK

Appearance
Dist
Diagnosis

Answer 4

Erythematous, ill marginated patch/papule with a roguh, yellowish brown adheretn scale

Feels like sandpaper…easier to feel than see so palpation key

Sun exposed areas and present on sun damaged skin

Clinical…skin biopsy only if thick and indurated or unresponsive to tx

Question 5

AK tx

Answer 5

SHould be treated but unpredictable

Prevention - decrease sun exposure

Initial - cryotherapy with liquid nitrogen (most common)

Alternatives are

topical 5-fluroura - interferes with DNA synthesis resulting in apoptosis and cell death in the sun damaged skin…warn the patients about discomfort

Imiquinmod - induces immune system to attack AKs in immunocompetent**

Question 6

SCC etiology

Answer 6

Malignant neoplasm from keratinocytes

UV light causes mutations that accumulate resulting in grwoth advantage for those damaged cells

Question 7

SCC common and risk factors

Answer 7

Fair skin, etc

UV, sunburns, chemical exposure (arsenic), immunosuppression, HPV, Cigs

Question 8

SCC prevalence

Answer 8

Most in men over 60 with light skin and lots of expsoure

Second most common

Question 9

SCC

Morph, distribtuion, sx

Answer 9

Scaling, indurated plaque or nodule that may bleed or ulcerate

Most occur on head, neck, extensor arms

Pruritic, tender, friable, non-healing bleeding grwoth /ulcer

Question 10

SCC diagnosis and dermatopathology

Answer 10

Skin biopsy

SCC in situe - no dermal involvement and can progress

INvasive SCC - invaded the dermis

Question 11

SCC tx

Answer 11

Refer to derm

Excise - most lesions…SOC

Curettage and electrodessication - reserved for in situ dz or shallow lesions…high rate of recurrent

Poor surgical candidates and adjuvant therapy - radiation

Question 12

Mohs micrographic survery

Indications

Answer 12

Real time eval of tumor margins
Maximize tissue conservation
Recurrence rates low

Indistinct borders - nose, eras, eyes, lips, scalp, hands

Question 13

SCC course

Where
…rate

Answer 13

Metastasis to regional lymph nodes

Diameter more thnan 2 cm or deeper than 4 mm
Recurrent
Immuosuppressed

Ears, scalp, non-bearing lip

Arising in scars, chronic ulcers, burns, isnus tracts, genitalia

Higher rate of metastasis than BCC so higher mortality

Question 14

Keratocanthoma

What is it, epi, CM, Tx

Answer 14

Form of rapidly growing SCC…may involute and regress

Most over 40

Ealry lesion is solitary, round nodules, rapid grwoth

Maturing - central keratotic plug visible and lesion is crater like

Tx - refer to derm for excision

Question 15

Bowen dz

CM…genital vs. non

Answer 15

Form of in situ SCC

Cricumscribed erythematous or pigmentated patches with keratotis surface

Genital - caused by HPV so screen

If non-gen in sunprotected areas, look for arsenic ingestion or internal malignancy

Question 16

Bowne dz

Metast
Tx
Recurrence

Answer 16

13-33% risk

Refer to derm…excise and debulk

High risk and malginant cells extend along follicles into dermis

Question 17

BCC

Etiology
Risk
Appearane
Diagnosis

Answer 17

Most common

Basal layer of epidermis

UV rays and PTCH (tumor suppressor) mutation

Fair skin, fale, over 60, easliy bleeding lesions

Most common and head and neck and depends on type

Skin biopsy

Question 18

Nodular and pigmented BCC

Answer 18

Nodular - most common…face (more on nose)…papule or nodule, translucent or pearly…central depression or crater…telangiectasias with rolled away border

Shiny, blue-black papule, nodule or plaque…pigment is speckled

Question 19

Superficial and slcerosing (scarring) BCC

Answer 19

Super - most freq on thorax…red, slightly scaling, well demaracted, eczematous like patch…centrally may be slightly eroded and crusted

Least common and most aggressive…atrophic, smooth, flesh colored…firm, indurated, ill defined borders, scar like

Question 20

BCC tx

Answer 20

Excision

Curettage and electrodessication for in situ or shallow

Question 21

BCC natural coruse

Metastassi

Answer 21

Locally invasive

Metastasis is rare

Location more on nose and ear
Over 2 cm
Histologic pattern (scleorsing or infiltrative)

Question 22

Kaposi sarcoma

Most affected
Type of condition
Diagnosis
Tx

Answer 22

Vascular neoplastic condition (HHV 8 infection)…endothelial cell origin

Purple macules, papules, and nodules

Can also affect mucous membranes, GI, LN, lungs

Refer to derm

Initial - radiation, excision or cryotherapy

Alt - intralesional or systemic chemo or IFN alpha

Question 23

HIV and skin cancer

Answer 23

BCC or SCC is most common

BCC is more common in HIV…SCC in organ transplant

HIV also more developing HPV associated and invasice SCCs

Melanoma in HIV more aggressive